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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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TUBERCULOSIS WITH PLEURAL EFFUSION AND PNEUMOTHORAX - STILL A MAJOR COMPLICATION

Rui Domingues1, Ivan Bravio2, Flora Candeias1, Cristina Borges3, Paula Kjollerstrom4, Maria João Brito1

1 - Unidade de Infecciologia, Área da Mulher, Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
2 - Unidade de Cirurgia Torácica, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisboa
3 - Unidade de Cirurgia Pediátrica, Área da Mulher, Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
4 - Unidade de Hematologia, Área da Mulher, Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa

- 2016 European Society for Paediatric Infectious Diseases Conference, Brighton UK, 10-14 de Maio de 2016 (Poster)

Resumo:
Introduction: In Portugal, tuberculosis remains an important public health issue in endemic areas. Any patient with pneumonia, pleural effusion, a cavitary or mass lesion in the lung that does not improve with antibacterial therapy should be screened for tuberculosis.
Clinical case: A 16-year-old adolescent male was admitted with a two month history of high-grade fever (40ºC), cough, left chest pain, night sweat and weight loss. The lung auscultation revealed a left decreased vesicular murmur and crackles. He had anemia, normal white blood cell count (5900/mcL) and positive IGRA. Tuberculin skin testing was anergic. He also had elevated prothrombin time (20.6s), APTT (38.9s) and a mild factor VII deficiency (30%) was detected. The chest ultrasound revealed left pleural effusion (340 mL), bronchoscopy described grade II inflammation and the cytology of bronchoalveolar lavage was negative for AARB (PCR) and cultural examination positive for Mycobacterium tuberculosis. The chest computed tomography confirmed pleural effusion with characteristics of organizing empyema and left lower lobe atelectasis. Pleural biopsy and thoracic drainage was performed by thoracoscopy. The biopsy revealed caseatiing granulomatous inflammatory process and treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was initiated. Due to persistent air leak and an incarcerated lung he underwent formal decortication by left thoracotomy after completing 1 month of treatment. The patient showed a progressive improvement of his clinical and radiologic condition, completed nine months of anti-bacillary therapy and was able to return to his normal life with minimal radiological sequelae.
Conclusion: Tuberculosis is a potentially life threatening disease. The physician has to make the diagnosis and initiate treatment as soon as possible. Suspicion is of utmost importance especially in countries with a low prevalence.

Palavras Chave: Tuberculosis, pleural effusion.